Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-Cov-2 Infection (PIMS-TS): Kawasaki-Like Multisystem Inflammatory Syndrome in Children (MIS-C) During the COVID-19 Pandemic with Predominant Myocarditis

Kawasaki-Like Multisystem Inflammatory Syndrome in Children (MIS-C) During the COVID-19 Pandemic

Abstract

During the COVID-19 pandemic, a Kawasaki-like multisystem inflammatory syndrome with predominant myocarditis associated with SARS-CoV-2 infection has recently been reported, now referred to as Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19, or Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 infection (PIMS-TS). These pediatric patients present with features that overlap features of Kawasaki Disease (KD) and toxic shock syndrome, albeit with distinct differences that relate to more common myocardial involvement requiring vasopressor support in PIMS-TS/MIS-C compared to KD (~50% vs ~5%), and less common coronary artery aneurysms (~9% vs ~25%). PIMS-TS/MIS-C seems to be largely immune-mediated, triggered by COVID-19, with the induced hyperinflammatory syndrome possibly due to post-infectious cytokine storm, rather than a result of direct cell injury caused by the virus. Treatment of this syndrome is similar to KD and includes intravenous immunoglobulin (IVIG), corticosteroids, and antiplatelet agents, while a few patients have also received interleukin-6 (IL-6) inhibitors. Rhythmos 2020;15(3):42-46.